Radiofrequency ablation (RFA) — also called radiofrequency neurotomy — is a minimally invasive procedure that uses heat energy to disrupt the small nerves responsible for transmitting pain from arthritic or injured facet joints. For patients who have confirmed facet-mediated spine pain with positive medial branch blocks, RFA offers one of the most durable non-surgical pain relief options available — with relief typically lasting 6 to 12 months or longer.
At our Miami clinic, Dr. William Bonner performs RFA under fluoroscopic (X-ray) guidance to ensure precise needle placement and to maximize both safety and effectiveness.
RFA works by delivering a controlled radiofrequency electrical current through a specialized needle electrode placed along the medial branch nerves — the small nerves that carry pain signals from the facet joints to the brain. The current generates heat at the tip of the electrode, which disrupts nerve conduction and interrupts the pain signal.
The result is a significant reduction in facet-mediated pain that can last from several months to well over a year. Over time, nerves can regenerate — at which point the procedure can be repeated if symptoms return.
Important: RFA does not damage the facet joint itself, only the small pain-transmitting nerves are targeted.
RFA is not a first-line treatment — it follows a specific diagnostic pathway. You may be a candidate for RFA if you:
Patients who have not completed the two-block diagnostic protocol are not yet candidates for RFA. If you have not had medial branch blocks, the first step is a diagnostic medial branch block evaluation.
RFA is not typically indicated for disc-related pain or nerve root compression (radiculopathy/sciatica) — those conditions have different treatment pathways.
Two separate positive medial branch blocks confirming facet-mediated pain are required before RFA is performed. These are typically done on different visits, with careful pain tracking after each procedure.
Once candidacy is confirmed, RFA is performed under fluoroscopic guidance. Multiple levels are often treated in the same session, depending on your diagnosis.
Most patients resume normal activities within a few days to a week. Physical therapy may be recommended alongside RFA to address contributing movement dysfunction and maximize long-term outcomes.
Relief from RFA typically lasts 6–12 months or longer. As nerves regenerate over time, symptoms may gradually return — at which point the procedure can be repeated if the patient again responds positively to confirmatory diagnostic blocks.
Precise electrode placement is fundamental to both the safety and effectiveness of radiofrequency ablation. The medial branch nerves are located at specific anatomical landmarks that cannot be reliably targeted without real-time imaging. Without fluoroscopic guidance:
Dr. Bonner performs all RFA procedures under fluoroscopic guidance with contrast confirmation and pre-ablation nerve testing as the standard of care.
The procedure is performed in-office and typically takes 30 to 60 minutes depending on how many levels are treated:
Most patients experience mild soreness in the treated area for several days following the procedure. Full relief may develop gradually over 2–6 weeks as the nerve disruption takes effect.
| Treatment | Duration of Relief | Best For |
| Facet Joint Injection | Weeks to months | Diagnostic + acute therapeutic relief |
| Medial Branch Block | Hours to days (diagnostic phase) | Diagnosis, pre-RFA confirmation |
| Radiofrequency Ablation (RFA) | 6–12+ months | Confirmed facet pain, longer-lasting relief |
| Physical Therapy | Long-term with compliance | Supportive; addresses movement dysfunction |
| Repeat RFA | 6–12+ months per treatment | When nerves regenerate and symptoms return |
Relief develops pretty soon after RFA. Many patients notice improvement within 1–3 weeks, with maximum benefit typically felt by 4–6 weeks after the procedure.
The procedure is performed under local anesthesia and is generally well-tolerated. Patients typically experience mild discomfort from the numbing injections. A brief burning or aching sensation may occur during energy delivery, but this resolves quickly. Post-procedure soreness for several days is common and expected.
Most patients experience meaningful pain relief for 6 to 12 months, and some maintain relief for 18 months or longer. Results vary based on the number of levels treated, the extent of degeneration, and individual factors.
Yes. As the medial branch nerves gradually regenerate over time, symptoms may return. If this occurs, the diagnostic protocol (medial branch blocks) is typically repeated to confirm ongoing facet-mediated pain, and RFA can be performed again.
No. RFA specifically targets the small medial branch nerves that supply the facet joint. It does not damage the joint capsule, cartilage, surrounding muscles, or other spinal structures.
Physical therapy is often recommended alongside RFA. The pain relief provided by RFA creates a window of opportunity to engage more effectively in rehabilitation — strengthening the muscles that support the spine and addressing contributing movement problems that may have developed due to chronic pain.
Radiofrequency ablation is covered by many insurance plans when appropriate diagnostic criteria are met — including two positive medial branch blocks. Dr. Bonner’s team will work with you to verify coverage and navigate prior authorization requirements.
If you are experiencing neck pain or low back pain, or other spine-related symptoms and want to determine whether an radiofrequency ablation (RFA) is appropriate for you, we are here to help.
Contact our Miami clinic to schedule an appointment with Dr. Bonner, or book online through ZocDoc for available appointment times (if you do not see availability, please reach out to us directly at 786-522-4959).
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